Provider Demographics
NPI:1578681649
Name:PROGRESSIVE NEURO-PSYCHIATRY, P.C.
Entity Type:Organization
Organization Name:PROGRESSIVE NEURO-PSYCHIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZUNIGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-299-4211
Mailing Address - Street 1:29240 BUCKINGHAM ST
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4575
Mailing Address - Country:US
Mailing Address - Phone:248-299-4211
Mailing Address - Fax:248-299-2392
Practice Address - Street 1:29240 BUCKINGHAM ST
Practice Address - Street 2:SUITE 8A
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-4575
Practice Address - Country:US
Practice Address - Phone:248-299-4211
Practice Address - Fax:248-299-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI033694103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty